We aim to establish a pediatric Center for Education and Research on Therapeutics (CERTs) Research Center (RC) with the theme of improving care and outcomes for children by optimizing the use of therapeutics. Subthemes are quality and safety. With a core infrastructure at Cincinnati Children's Hospital Medical Center (CCHMC) and regional and national partnerships to enhance spread and translation into practice and policy, significant innovations in patient safety, comparative effectiveness and improvements in care can be achieved. Five projects are planned: 1) Reduce unsafe ICU transfers and the need for therapeutic interventions by using situation awareness, a high reliability strategy;2) Predict and prevent acute kidney injury in hospitalized children receiving nephrotoxic medications by testing, refining, and spreading a trigger tool and mitigation intervention;3) Compare the effectiveness of antibiotics for the most common serious bacterial infection in children, community acquired pneumonia, using a health system population database;4) Evaluate diffusion and implementation strategies to prevent prematurity and related lung problems by using antenatal corticosteroids and 17-hydroxyprogesterone, in a statewide perinatal network;and 5) Ensure safe use of disease-modifying anti-rheumatic drugs, and develop a shared decision-making tool, in a pediatric network for the 6th most common cause of childhood disease, arthritis. We will use CCHMC and Learning Networks (multi-site collaborations of patients/families, clinicians, and researchers) as the innovation engines and laboratories that can help standardize care so that new approaches can be evaluated effectively and efficiently to improve therapeutic care and health outcomes for children. In addition, we propose activities that explore planned experimentation in complex health systems, and the ethics and data sharing policies needed to enable large registry studies. PUBLIC HEALTH RELEVANCE: Children have unique needs, types and severity of illness that create special challenges for pediatric therapeutics. Their care is suboptimal. This CERTs will focus on translating research into practice to improve quality and safety so that every child gets the right therapeutic at the right time in the right way--every time.